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[MeanGoal]

For tibial lengthening, I read that gastrocnemius recession is necessary if the patient lengthens somewhere between 4.0cm to 4.5cm or more. Does that mean if tibial lengthening is done below a certain limit (such as under 3.6cm), gastrocnemius recession is not necessary?

[ReadRothbard]

It's not always necessary. It depends on how flexible your calves are. MDOW did 8 cm and didn't need it.

[Jokerhastowait2022]

If you do physio rigorously, 5-6 would be possible without recession depending on the initial flexibility IMO.

[zaozari]

For tibial lengthening, I read that gastrocnemius recession is necessary if the patient lengthens somewhere between 4.0cm to 4.5cm or more. Does that mean if tibial lengthening is done below a certain limit (such as under 3.6cm), gastrocnemius recession is not necessary?

It's the first time I read this and astonishingly as "necessary" and I am doing research for years. Can you reference your sources?
And just because of 3 or 4 cm if you do proper lenghtening physiotherapy and previous examination of muscle? You need to cut out muscle?! You don't even stop lenghtening first?

[Height Journey]

Although I am a femur lengthener, I found this article on tibial lengthening and gastrocsoleus recession.

What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397743/

Summary:
Amount and percentage of lengthening, age, and etiology were risk factors for GSR. Patients with lengthening of greater than 42 mm, lengthening of greater than 13% of lengthening, and congenital etiology were more likely to undergo GSR. Adjusting for all other variables, increased amount lengthened and age were associated with undergoing GSR.

[zaozari]

Then it's a real issue in some cases despite this was not studied in healthy patients undergoing pure cosmetic lenghtening. For some reason is never cited in the list of complications for example of Paley, Catagni and Guichet.
Fortunately and at least for my own judgement, after all research I did it seems unlikely in day to day practice of CLL.
And even In these pathological article cases it says: "dorsiflexion was mantained or restored similarly among patients with or without GSR when treated under our algorithm".

[MeanGoal]

In addition to Height Journey's reference (which I also found), here is another study by Dr Rozbruch.

https://www.hss.edu/files/LL-role-and-outcome-of-gastrocnemius-recession-in-tibial-lengthening.pdf

Role and Outcome of Gastrocnemius Recession in Tibial Lengthening

Risk factors that led to need for GR were amount and percent of lengthening of 49 mm and 15% [of original tibia length] respectively, congenital etiology, and previous surgery.

[zaozari]

It's a preliminary version of the same article, based on roughly the same patients. As a prospective CLLer, for me, it's one more call out for healthy cosmetic lenghteners to insist on their lenghtening physiotherapy as this muscle is really one of the strongest in the all body.
Probably some doctors are right when they say this training should even start at least one month before CLL surgey.